My ABA Confessions Continued… Lesson #2… TIME Matters!

A few days ago, I started a ‘confessional’ post that explores ways that I, a professed Floortimer, am actually closer to an ABA model than I ever dreamed. If you missed the first installment in this series, you can read it here:

TIME MATTERS!

One of the reasons I’ve always thought that ABA was successful is the way they handle the time issue.

ABA therapists don’t mess around with telling you how much TIME it takes to help a child with significant development delays make progress. They unapologetically schedule toddlers – that’s two- and three-year-olds – for ten to twenty hours a week of treatment, sometimes more.

As an SLP, seeing toddlers for two or more hours of therapy per week wasn’t unusual back in the good ole days – before “unit caps” and “primary service provider” models. Now, the norm for therapy time across the county for most kids is about an hour a week for speech therapy.

Here’s the truth about that amount of therapy time:

I can make progress in that limited amount of time with a child. I’ve seen it over and over, so no one can tell me it can’t be done.

BUT the children who’ve made the most progress with me have had parents who are fully invested in faithfully working with their own child all day, every day. This successful therapy continues long after I leave and begins long before I see them for the next week’s session.

AND, as the “natural environment” proponents like to recommend, therapy time for these families isn’t five minutes here or ten minutes there as they complete the routine tasks of their day. Most of the time, parents of the children who make fantastic progress devote HOURS of time to working directly with their child most every day. Much of that time is spent in fairly structured tasks too (more about that tomorrow!).

Hard Recommendation for Busy Parents

Sometimes speech-language pathologists in early intervention programs shy away from telling a parent just how much time it really takes to ‘make therapy stick’ or to help a child make progress from a moderate delay to catching up with peers his own age. Or, when they do talk to a parent about setting aside some special time, they say things like: “Read one book a day” with some special instructions, or maybe even things like: “Try to get in at least twenty minutes of playing with her every day.”

I’ve never messed around with telling a parent that a child will catch up with therapy alone, with no effort on their part, or that they can expect big gains from tweaking a few things here and there. Nope. I’m a homework giver. I ask questions:

“How did that work for you last week at home?”

“We’re not making nearly enough progress here; how are you working with her?”

“I know you can make faster progress if you work with her more. What can you do differently to make that work?”

When very committed parents who are obviously ‘all in’ say gut-wrenching things to me like, “Tell me the truth. What can I do? What will it take for my child to have a chance to catch up?”

I look them straight in the eye and say: “This is going to take hours and hours on your part, especially in the beginning. If you’re doing it right, your house will be dirty. Your laundry will pile up. Your husband (or wife!) may not get a home-cooked meal for a while, but everyone will survive, and it will be worth it.”

There’s just no getting around that time requirement, particularly for children who have moderate to significant developmental delays or a diagnosis that predisposes them to lifelong challenges with communication. In order to make progress, working on new skills will take a chunk of time most days.

That’s one more thing the ABA people had right all along!

What about Floortime?

In all fairness, the original time recommendation for Floortime was twenty to twenty-five hours a week in order for a child to make significant gains. Dr. Greenspan, the originator of Floortime, also recognized that most of the time would be left to parents, since most families cannot afford that amount of therapy time. This is the same guideline I share with parents from the beginning:

20 to 25 Hours a Week

When a mom balks at that level of commitment, I always say, “Let’s start with what you can realistically do.”

For some families, it is as little as a thirty-minute block of time once a day, but I always encourage them to shoot for two or three times a day as many days as they can. Often a mom sees so much initial success that she works up to more and more time on her own. She’s in – and then my focus becomes how I can support her versus how I can manage her time. I’m not the therapy police either. There are no penalties or lectures from me for families who can’t manage to do that beyond those initial conversations.

It is trickier when both parents work, and even worse for single parents. As a mother who’s worked full-time forever, I understand the challenges. I talk to parents about that – yes, dads too! There’s usually a way to work out some time for a toddler at home, and it will probably mean setting new priorities, especially in the beginning of treatment. It will be harder for everyone in that family.

But here’s the thing… if we can shuffle older kids to soccer, ballet, sleep-overs, church activities, and whatever else they have going on, we can find time to devote to a toddler who is struggling. If a mom can find time to browse Pinterest or scroll endlessly through Twitter and Facebook, she can squeeze in at least a little time with her own child. If a dad likes his shows or his games or whatever he’s in to, a little less of that may be the time that’s shifted to this very important “to do.” I’ve been lucky enough to see my share of dads who take the reins and make this work in families.

Some parents can’t let go of any of their responsibilities to devote the extra time to another task in their busy days. In my career I’ve seen families from all socio-economic levels and educational backgrounds devise clever solutions to solving the time crunch, ranging from recruiting a grandparent or another caring adult, hiring a special sitter for a few hours a week, and even enrolling a child in a special preschool or adding additional therapy services to fill the gap. It may have been hard for them, but was doable.

This position may be a tougher one than you want to adopt with parents. I’ve come to think of it this way – I’m not the enforcer, but I am the bearer of the message:

“This is what I would do with my own kids and this is what I’ve seen work.”

I appreciate the consistency regarding time between Floortime and ABA, but here’s what I see happening now. Many SLPs, particularly those who adhere to a strict ‘consultative’ or ‘coaching’ model, water-down the time recommendation for parents. They often focus on teaching a mom to tweak things here and there without providing a realistic time-commitment guideline that illustrates what they should be doing if they really want to make a difference.

Even worse, some SLPs assume that a parent isn’t willing or won’t be able to commit that much of their week to working with their child, so they never share any recommendation about time at all.

If that’s you, I am empowering you to STOP DOING THAT TODAY. We must share solid information with families about working with their own children. It’s up to them to figure out how to make that work in their lives. But the bottom line is this:

For most parents, ordering the 3 DVD Set (Teach Me To Talk: The DVD and Teach Me To Listen and Obey 1 & 2) will be the best choice so that parents can SEE play-based therapy strategies with a variety of toddlers with both receptive and expressive language delays. The 3 DVD Set is specially priced at $84.99. Order that set here.

For parents who are looking for more specific instructions for how to engage a toddler who is difficult to connect with and teach during play, Teach Me To Play WITH You, is also recommended in addition to the 3 DVD set. This is bundled as the Helping Toddlers with Autism Set. Order this set.

For very committed parents who want a detailed step-by-step explanation of “how to” and “what to” work on for at-home therapy, order Teach Me To Talk: The Therapy Manual, Teach Me To Play WITH You and the 3 DVD Set. This combination is also recommended for professionals who need additional resources and teaching tools to help families of toddlers who have been (or will be) newly diagnosed with autism. This set is bundled as the Helping Toddlers with Autism Comprehensive Set. Order that set with this link.

About

Laura Mize is a pediatric speech-language pathologist who specializes in treating young children, ages birth to three, with communication delays and disorders in her private practice in and around Louisville, Kentucky. She earned a B.S. in … [Read More...]